pays for your hospital bills for diagnostics, surgery etc.
We have all heard of, and are familiar with, the concept of health insurance. The Mediclaim industry has evolved in providing services to clients, and has made it easy for customers to enjoy the benefits of their health Policy with cashless facility. What exactly is cashless facility, and how does it come to benefit clients of health insurance?
This is the time and age where diseases abound, where hospitalisation is not as far as we initially thought it was. When hospitalisation becomes inevitable and when clients of Health Insurance get admitted to a network hospital, the immediate problem that arises is that of paying to the hospital and settling the bills. Of course, the role of mediclaim is to reimburse the expenses that you may have incurred in the process of getting admitted to the hospital. But then, what about the immediate strain that such hospitalisation would have on your budgets and your liquid cash?
Fortunately, cashless facility provides the distinct advantage where you would no longer have to worry about your immediate liquidity, especially since hospitalisation happens all of a sudden, and not in a planned fashion.
One of the first things that you should note with regard to availing cashless facility in health policy is that this is a benefit that is available only in a network hospital. Your insurance provider would have had arrangements with certain hospitals or chains of hospitals and their different branches. It is this agreement with its terms that gets executed for your convenience when you get hospitalised and when you are looking for cashless facility.
It is important to note that you need to get admitted only to a network hospital that has prior arrangements in place with the insurance provider. If you were to get admitted in any other hospital, you may not be able to avail of the cashless facility. Further, you would also be well advised to check with your insurance provider, check the terms of your health policy, and check the websites of the hospital as well as your health insurance company to ensure that the hospital of your choice is a network hospital with all the required authorisations, to avoid Claim rejection later.
If you were to get admitted in a hospital that is not authorised and that does not have arrangements in place with the provider of health insurance, you would still be eligible for mediclaim, where you could get your medical expenses reimbursed, within the terms and conditions of your health policy, as in the case of sum assured, and if you have been regular in the payment of health insurance premium. It is important to keep your insurance policy active and stick to the terms and conditions as provided in your health insurance to avoid claim rejection, irrespective of whether you get hospitalised in a network hospital or not.
Authorisation refers to the process where your health insurance provider or TPA approves of the claims that have been put forward by you for cashless hospitalisation. It may be noted that it could take a minimum of 24 hours for the claims to be verified and approved. If the reasons why you get admitted to a network hospital have to do with planned surgeries, you would necessarily have to get authorisation from your health insurance provider. However, if it were an emergency that you get hospitalised for, the processing would be done at the earliest possible timeframe – lack of authorisation would not be a reason for claim rejection in such cases.